Introduction:
Periodontal diseases are a group of inflammatory processes that affect the tooth-supporting structures which, if left untreated, can progress and cause bone loss, thereby impairing the survival of the teeth.1-3. Maxillary molars are the most commonly lost teeth, followed by the mandibular molars. 4,5
Treatment of periodontal disease focuses mainly on arresting disease progression and preserving the form and function of the dentition involved. Managing periodontal disease around multirooted teeth is challenging for periodontists because of the complex anatomy of the tooth furcation area, which favors plaque accumulation and hinders personal and professional cleaning attempts. The furcation is defined as the anatomic area of a multirooted tooth in which the roots diverge, and pathologic resorption of the bone in this region is known as “furcation involvement.” 6
Furcation involvement is associated with a poor prognosis and higher tendency for tooth loss 4 due to the complex anatomy7,8 9 and difficulty in maintaining oral hygiene, performing periodontal debridement10-13, and periodontal maintenance5. Several treatment options have been proposed to manage furcation involvement by cleaning the area and rendering it more cleansable. Treatment options vary according to the degree of furcation involvement and patient- and clinician-related factors and include simple debridement of the defect using either closed or surgical approaches; furcation plasty/osseous plasty; regenerative approaches involving guided tissue regeneration around the furcation; and resective approaches involving tunneling 14, root resection/amputation, or hemisection. In case of failure of these options, tooth extraction is necessary.
Root amputation and hemisection are the least desired approaches by both patients and clinicians because of the assumption of inferior results compared with other therapies, such as dental implants. However, this assumption is contrary to the findings in several studies that reported high success rates when these procedures were performed correctly on properly selected patients. Herein, we present the 14-year follow-up of a maxillary right first molar (tooth #16) in which root amputation was performed and explain how this procedure saved the tooth during cancer treatment.
Case history: A 33-year-old woman was referred to our periodontal department by a prosthodontist for surgical crown lengthening of the endodontically treated tooth #16. The patient was medically fit and did not smoke. Clinical examination revealed fair oral hygiene with calculus deposition over the mandibular anterior teeth. Periodontal evaluation revealed a localized deep periodontal pocket with a probing depth (PD) of 6–7 mm distal to tooth #16 and distal grade 2 furcation involvement. 15 In addition, a periodontal pocket with a PD of 4–5 mm and grade 1 furcation involvement distal to tooth #26, 2 mm gingival recession around tooth #46 with lingual grade 2 furcation involvement, gingival recession on the lingual of the mandibular anterior teeth and buccal of tooth #34 Recession type two (RT 2) 16, and short anterior crowns were observed. The patient had class 1 molar and canine relationships on both sides according to Angle’s classification ( Figure 1).